EverythingHealth is designed to address the rapid changes in Science, Medicine, Health and Healing in the 21st Century. This site will sift through the vast amount of confusing data and simplify issues that are of interest to everyone interested in a healthy life and longevity. The writings on EverythingHealth are entirely my own views and opinions.

Sunday, January 10, 2010

What No One Tells You About Fertility

I can't tell you the number of times women in their mid 40's come to me and announce "Well, I'm ready to get pregnant". Putting off pregnancy is understandable in our times. Women are building their careers, moving and traveling, going through a series of "Mr. Wrongs" and looking for the best baby-daddy. Women have thought that fertility was a given and they could get pregnant when the time was right. But, sadly, what they haven't been told is the cruel trick of nature. Fertility doctors know...after age 29 your chance of having a baby without medical treatment is diminishing every year. After age 40 there is a precipitous drop.

To bring that fact home, check this out. A woman age 19-26 has a 50% chance of getting pregnant during any one menstrual cycle if she has intercourse two days prior to ovulation. For women age 27-34 the chance was 40% and after age 35 it drops to 30%. And at 40 you are only 1/2 as fertile as you were at 35. That is a sharp drop off!

Why does fertility decline with age? There are a number of reasons that compound each other:

Eggs- The number of egg follicles left in the ovaries declines with age and no new ones are made.

Menstrual cycle - as women age the cycle can become irregular and shorter.

Lining of the womb - the endometrium is thinner and less hospitable to a fertilized egg.

Mucus secretions - the vaginal secretions can be less hospitable to sperm.

Other diseases - endometriosis, chlamydia and polycystic ovary syndrome(PCOS) can play a role in preventing pregnancy.

The female reproductive cycle is very complex biology. A newborn baby girl's ovaries store a woman's lifetime supply of immature eggs - about 400,000 - and with time, those eggs become less viable and healthy. The hormones released during the menstrual cycle control the sequence of events that lead to pregnancy. With age, those hormones fluctuate and cannot support a pregnancy.

Advanced fertility treatment can help many older women become pregnant. The average cost of an in-vitro fertilization (IVF) cycle in the U.S. is $12,400. That is after a complete (expensive) hormonal workup and exam. For women over age 40, fewer than 1 in 12 cycles results in a pregnancy. If a woman over age 40 is able the have a baby, the medical cost per delivery is $132,000. About 11% of IVF pregnancies end in miscarriage. Very few women over age 43 will attempt IVF and very few clinics will even offer it.

Bottom line is IVF cannot reverse aging. The number and quality of eggs remaining is the major factor in women over age 40 getting pregnant and IVF cannot change those factors.

For women over age 40 who have wanted to have children , these facts are a slap in the face. Doctors have talked about birth control for years but few doctors gave the information about fertility and women say "Why didn't I know this?"

And what about those movie stars who are in late 40's having babies? It is not their egg, or they are using a surrogate or they are adopting. Period.

Gynecologists should give their patients this information ahead of time so they have this knowledge before it is too late. I went every year for my annual check up and was healthy and knew that chances reduce with age but thought I still had some chances left for awhile. I wish this was clearly explained to me about the time frame, reasons, with what happens in the body, so there would have been a possibility. Patients would be grateful, appreciative and have more respect for their GYN or Primary Care doctor, or Nurse Practitioner if they had this discussion while still young enough or even gave them a brochure, if time didn't allow with the doctors rushed schedule of having to fit so many people in. When a doctor doesn't bring it up, because it might be uncomfortable it is a a disservice to their patient.

This is wonderful of you to bring this up Dr.Brayer and write about it in such a clear, educative manor, even though it is sad and depressing, it might help some women before ending up in my situation, and give the ones with a chance and time hope. I wish my doctor had been like you in discussing these details with me.

This is very insightful! As always knowledge is power. I think it's good news for a woman like myself who doesn't want children and may want to explore other non-hormonal birth control options. Thanks!

After working in an OB/GYN office for 17 years I found the following to be true: the people who seemed barely able to take care of themselves, regardless of the reasons why (substance abuse, no education, bad luck, etc) were invariably the individuals who seemed to have no problem whatsoever conceiving.

Sigh. I can only *wish* those numbers on fertility dropping applied to me.

I was 25 when I had my first baby...now I'm 37 and have 5 children. I've gotten pregnant while using birth control 3 times times. I can confidentally say that I've NEVER had unprotected sex within 2 days of ovulation and failed to get pregnant.

Knitted in the Womb: Wow, you are fertile. It sounds like a heap of blessings (and a lot of hard work). Don't forget...in the 20's you are major fertile. It only drops later. But in your case you better be really really careful even going forward!

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About Me

I am an Internal Medicine physician who has practiced for over 30 years in Northern California. I was previously the President of the SF Medical Society and Chief of Staff at a large academic medical center. I am currently the Chief Executive Officer for a large Physician and health care provider group in Northern
California. My practice is smaller now
but caring for patients is still the most important part of my work. I love taking care of patients one:one as well as influencing health care at a larger level.
The information on this site is not designed to replace a physician's advice.
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